The orthopaedic consequences of civil disturbance in Northern Ireland.

For several hundred years, rival factions within the religious communities of Ireland have had their differences. The division of Ireland in 1920 into a predominantly Protestant North and Catholic South emphasised the geographic, political and ethnic polarisation of the island. Violence, however, had been sporadic and relatively short-lived until the current civil disturbance in Northern Ireland, euphemistically referred to as ‘the troubles’, began in 1969. There have now been 20 years ofcontinuous violence by a number of terrorist groups ; almost every conceivable weapon has been used. Over 2 600 people have been killed and more than 30 000 injured. In a relatively static population of 1 .5 million, where there had been only one murder in the 10 years before 1969, this represents an horrific increase in the level of violence, leaving few untouched. However, this must be seen in perspective road accidents in Northern Ireland have claimed over 5 000 lives and injured 150 000 people within the same period. In only one of 19 years has the death toll from civil disturbance exceeded that from road traffic accidents (Fig. 1). The victims of the troubles have included both civilians and members of the security forces (Fig. 2). general surgeons. These have coped admirably with both initial and continuing patient care (Brown and Marshall 1988). Specialist opinion is available by telephone or from a visit by the appropriate consultant but, provided the patient’s condition is stable, transfer by road or by helicopter to a major centre is preferred. In the Belfast area, many of the serious civil